Apparatus and methods for treatment of arthrosis or osteoarthritis in a joint of a mammal or human patient

ABSTRACT

A proposed treatment of arthrosis/osteoarthritis in a joint of a mammal or human patient involves deposing a liquid material on at least one damaged surface of the joint. To accomplish this, a reservoir ( 110 ) is provided, which holds a volume of a biocompatible material in liquid form outside of a body containing the joint (J) to be treated. A proximal end (P) of a tube-shaped instrument ( 120 ) is connected to the reservoir ( 110 ), and a distal end (D) of the instrument ( 120 ) is inserted into the joint (J). The liquid material is fed through the instrument ( 120 ) to the distal end (D) for deposition on the at least one damaged joint surface. The material is configured to assume a solid form under predefined conditions (e.g. when cooling off or being exposed to a specific type of radiation). When the material has the solid form, it has a resistance to wear adapted to replace a worn out joint surface.

BACKGROUND

The present invention relates generally to surgical treatment of joints.More particularly the invention relates to an apparatus and methods fortreatment of arthrosis or osteoarthritis in a joint of a mammal or humanpatient.

Traditionally, surgical treatment of damaged joint surfaces (for examplein the hip or knee joint) has implied a relatively complicatedprocedure. For example, in case of arthrosis in the hip joint, asubstantial portion of the femoral bone is normally replaced with aprosthesis. This type of operation affects comparatively large musclesand/or many ligaments and tendons, which in turn, leads to a long periodof convalescence for the patient. Moreover, if only the cartilaginoustissue of the joint is damaged, it is actually unnecessary to remove thehealthy femoral bone tissue.

SUMMARY

The object is therefore to alleviate the above problems and provide anuncomplicated solution for treating arthrosis in joints, which minimizesthe removal of healthy tissue and decreases the period of convalescenceand the pain to the area of the joint.

According to one aspect, an apparatus for treatment comprises: areservoir configured to hold a volume of a biocompatible material inliquid form having a temperature higher than 100° C. outside of a bodycontaining a joint to be treated, and an instrument having a generaltube shape, a distal end of the instrument being configured to beinserted into the joint, a proximal end of the instrument beingconnected to the reservoir and configured to receive the liquid materialthere from, the instrument being configured to feed the liquid materialhaving a temperature higher than 100° C. from the proximal end to thedistal end for deposition on at least one damaged surface of the joint,such that adjacent nerves are damaged by the heat of the material, thematerial being configured to assume a solid form under predefinedconditions, and when in the solid form the material having a resistanceto wear adapted to replace a worn out joint surface.

According to one embodiment, the apparatus further includes a flexibleand collapsible mould member. This member has a pre-produced shapeadapted to a shape and size of at least one of the at least one damagedsurface. Thus, the mould member may contact and cover this jointsurface. Additionally, the mould member is configured to be insertedinto the joint, and be form-fitted to said damaged surface. The mouldmember is also configured to be connected to the distal end of theinstrument, and when placed in the joint (J) receive the material inliquid form being fed through the instrument. The mould member has aninternal volume configured to be filled with liquid material receivedvia the instrument. Moreover, the mould member is configured to enablethe predefined conditions for accomplishing a transition from the liquidform to the solid form after that the mould member has been filled withthe liquid material.

The mould member is advantageous, since it facilitates targeting apredetermined volume of the liquid material to a specific joint surfaceboth in terms of thickness and lateral coverage.

According to another aspect, the object is achieved by a method fortreatment of arthrosis in a joint of a mammal or human patient. Themethod involves feeding a volume of a bio compatible material in liquidform into a reservoir located outside of a body containing a joint to betreated. The method further involves inserting into the joint aninstrument having a general tube shape. A distal end of the instrumentis configured to be inserted into the joint, and a proximal end of theinstrument is connected to the reservoir. The method further involvesreceiving the liquid material from the reservoir in the instrument, andfeeding the liquid material from the proximal end to the distal end ofthe instrument. Thereafter, the material is deposed on at least onedamaged surface of the joint. Analogous to the above, the material isconfigured to assume a solid form under predefined conditions, and whenin the solid form the material has a resistance to wear adapted toreplace a worn out joint surface. In further analogy to the above,irregularities may be repaired on one or both of the opposing surfacesin the joint.

According to yet another aspect, the object is achieved by a surgicalmethod for treatment of arthrosis in a joint of a mammal or humanpatient. This method involves inserting in a first position anarthroscopic instrument into a joint to be treated. The instrument hereincludes a camera for viewing the joint. This method further involvesproviding a reservoir with a volume of a biocompatible material inliquid form outside of a body containing the joint. Moreover, the methodinvolves inserting into the joint an instrument having a general tubeshape. A distal end of the instrument is configured to be inserted intothe joint, and a proximal end of the instrument is connected to thereservoir. Additionally, the method involves receiving the liquidmaterial from the reservoir in the instrument, and feeding the liquidmaterial from the proximal end to the distal end of the instrument.Then, the material is deposed on at least one damaged surface of thejoint. The material is configured to assume a solid form underpredefined conditions, and again, when in the solid form the materialhas a resistance to wear adapted to replace a worn out joint surface.Naturally, here, the camera facilitates execution of the method.

According to a additional aspect, the object is achieved by a surgicalmethod for treatment of arthrosis in a joint of a mammal or humanpatient. The method involves inserting in a first position anarthroscopic instrument into a joint to be treated. Here, the instrumentincludes a camera for viewing the joint. The method further involvesinserting in at least one second position at least one surgicalinstrument into the joint. Moreover, the method involves providing areservoir with a volume of a biocompatible material in liquid formoutside of a body containing the joint. The method further involvesinserting into the joint an instrument having a general tube shape. Adistal end of the instrument is configured to be inserted into thejoint, and a proximal end of the instrument is connected to thereservoir. Furthermore, the method involves inserting a mould memberinto the joint. The mould member has a pre-produced shape adapted to ashape and size of at least one damaged surface of the joint, so ascontact and cover this surface when the mould member is placed in thejoint. The mould member is also flexible, collapsible and has aninternal volume configured to be filled with liquid material receivedvia the instrument. The mould member is connected to the distal end ofthe instrument. The method further involves form-fitting the mouldmember to said at least one damaged surface, injecting the material intothe mould member through the instrument, and receiving the material inthe mould member. Then, after that the mould member has been filled withthe liquid material, the material is caused to transition from theliquid form to a solid form. When in the solid form the material has aresistance to wear adapted to replace a worn out joint surface.

Here, the mould member facilitates targeting a predetermined volume ofthe liquid material to a specific joint surface both in terms ofthickness and lateral coverage. Hence, an even better end result may beattained.

According to yet another aspect, the object is achieved by a surgicalmethod for treatment of arthrosis in a joint of a mammal or humanpatient. The method involves inserting in a first position anarthroscopic instrument into a joint to be treated. Again, theinstrument includes a camera for viewing the joint. The method furtherinvolves inserting in at least one second position at least one surgicalinstrument into the joint. A reservoir is provided with a volume of abiocompatible material in liquid form outside of a body containing thejoint. The method also involves inserting into the joint an instrumenthaving a general tube shape. A distal end of the instrument isconfigured to be inserted into the joint, and a proximal end of theinstrument is connected to the reservoir. Furthermore, the method alsoinvolves inserting a mould member into the joint. The mould member has apre-produced shape adapted to a shape and size of at least one of thedamaged surface, so as contact and cover the damaged surface when themould member is placed in the joint. Additionally, the mould member isflexible, collapsible and has an internal volume configured to be filledwith liquid material received via the instrument. The mould member isconnected to the distal end of the instrument. The mould member is alsoform-fitted to the damaged surface, the material is injected into themould member through the instrument, the material is received in themould member. Then, after that the mould member has been filled with theliquid material, the method involves causing a transition of thematerial from the liquid form to a solid form. When in the solid formthe material having a resistance to wear adapted to replace a worn outjoint surface.

Preferably, the mould member is designed to be at least partiallyremoved after that the biocompatible material has become solid, and themethod involves removing (at least partially) the mould member from thejoint at an appropriate stage of the procedure. Alternatively, the mouldmember may be configured to disintegrate automatically, e.g. inconnection with the material becoming solid.

According to still another aspect, the object is achieved by a methodfor surgically placing the above-proposed apparatus in a patient via alaparoscopic abdominal approach. The method involves inserting atube-shaped instrument into the abdomen of the patient's body. Themethod also involves supplying gas into the patient's abdomen via thetube-shaped instrument, so as to expand the patient's abdominal cavity.At least two laparoscopic trocars are placed in the patient's body, anda camera is inserted through one of the laparoscopic trocars into thepatient's abdomen. Additionally, the method involves inserting at leastone dissecting tool through one of the at least two laparoscopictrocars. The method further involves dissecting a bone area opposite tothe hip region. At least one hole is drilled in the bone of the patientfrom the abdomen reaching the hip joint, and through this at least onehole surgery and treatment are performed for treating arthrosis orosteoarthritis of the hip by using the proposed apparatus. This approachis advantageous, since it provides convenient access to the hip joint,while leaving the musculature surrounding the hip joint essentiallyintact.

According to a further aspect, the object is achieved by a method forsurgically placing the above-proposed apparatus in a patient via afemoral bone approach. This method involves cutting the patient's skinat the lateral upper femoral region, and drilling at least one hole inthe bone of the patient through the upper femoral region reaching thehip joint. Surgery and treatment for treating arthrosis orosteoarthritis of the hip is then performed through this at least onehole by using the proposed apparatus. Hence, a damaged hip joint can betreated in a very straightforward manner, which causes a low degree ofdiscomfort to the patient. Also in this case, the musculaturesurrounding the hip joint is at most insignificantly influenced.

In any of the embodiments the material could comprise at least onematerial selected from the group consisting of: polytetrafluoroethylene,perfluoroalkoxy, fluorinated ethylene propylene, polyethylene, andacrylic polymer mixed with alumina trihydrate.

One advantage is that very small incisions is required. Thus, thehealing process after the surgery can be made relatively short.Moreover, no healthy bone tissue is removed unnecessarily. Furtheradvantages, beneficial features and applications will be apparent fromthe following description and the dependent claims.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments are now to be explained more closely, which are disclosed asexamples, and with reference to the attached drawings.

FIG. 1 schematically illustrates an apparatus according to oneembodiment;

FIG. 2 illustrates how the hip joint of a patient may be reachedaccording to two embodiments;

FIG. 3 schematically illustrates how a mould member adapted to a firstjoint surface is connected to the proposed apparatus according to afirst embodiment;

FIG. 4 schematically illustrates how a mould member adapted to a secondjoint surface is connected to the proposed apparatus according to asecond embodiment;

FIG. 5 illustrates how the knee joint of a patient may be treatedaccording to one embodiment;

FIG. 6 illustrates how laparoscopic/arthroscopic trocars are approachingthe hip joint from the abdominal side of the pelvic bone;

FIG. 7 illustrates how a hole is being created in the pelvic bone fromthe abdominal side thereof;

FIG. 8 illustrates how a small hole is being created in the pelvic bonefrom the abdominal side thereof;

FIG. 9 illustrates how a hole is being created in the femoral bone fromthe lateral side of the patient;

FIG. 10 illustrates how a hole has been created in the hip jointcapsule.

FIG. 11 a shows a mould placing instrument.

FIG. 11 b shows a mould placing instrument.

FIG. 11 c shows a mould placing instrument;

FIG. 12 shows the insertion of a mould;

FIG. 13 a shows the insertion of a mould;

FIG. 13 b shows the insertion of a mould;

FIG. 13 c shows the filling of a mould;

FIG. 13 d shows the hip joint in section after the mould has beenfilled;

FIG. 14 shows the placing of a mould in the knee joint;

FIG. 15 shows the placing of a mould in the knee joint;

FIG. 16 shows the filling of a mould in the hip joint;

FIG. 17 shows the filling of a mould in the hip joint;

FIG. 18 shows the filling of a mould in the hip joint;

FIG. 19 shows the hip joint in section after the mould has been filled;

FIG. 20 shows a medical device for injecting a fluid.

DETAILED DESCRIPTION

We refer initially to FIG. 1, which schematically illustrates anapparatus for treatment of arthrosis in a joint according to oneembodiment. Typically, the joint is included in a human patient.However, technically, any other mammal may equally well be treated bymeans of this apparatus, e.g. a horse.

The apparatus includes a reservoir 110 and an instrument 120. Thereservoir 110 is configured to hold a volume of a biocompatible materialin liquid form outside of a body containing a joint to be treated. Thebiocompatible material in the reservoir 110 is initially liquid.However, under predefined conditions the material is configured toassume a solid form. For instance, the material may be liquid when itstemperature is above a certain level, and solid otherwise; or it may beliquid until it is exposed to a specific type of radiation, sayultraviolet light. These aspects will be elaborated below. In any case,when in the solid form the material has a resistance to wear adapted toreplace a worn out joint surface.

The instrument 120 has a general tube shape, which may be substantiallymore elongated than what is apparent from the examples shown in FIG. 1.The instrument 120 may also be articulated (i.e. including one or morelinks), so as to enable a more convenient access to joint surfacesinside the body. Irrespective of the length and specific design of theinstrument 120, a distal end D thereof 120 is configured to be insertedinto the joint to be treated. A proximal end P of the instrument 120 isconnected to the reservoir 110 and configured to receive the material inliquid form from the reservoir 110. The instrument 120 is furtherconfigured to feed the liquid material from the proximal end P to thedistal end D, such that the material can be deposed on at least onedamaged joint surface. This instrument could also be inserted into thejoint via an arthroscopic trocar i.e. inside another tube, wherein theend of the instrument could be more flat.

According to one embodiment, it is presumed that the biocompatiblematerial in the reservoir 110 is liquid because it has an elevatedtemperature (i.e. above 37 degrees Celsius), say 50, 70, 90, 100, 150,200, 300 or 400 degrees Celsius, or any other temperature within aninterval from 37 to 500 degrees Celsius. Therefore, the reservoir 110 isconfigured to hold the biocompatible material at the temperature inquestion, i.e. 50, 70, 90, 100, 150, 200, 300, 400 degrees Celsius ormore. To this aim, the reservoir 110 preferably includes at least oneshield member 115, which is configured to isolate the reservoir 110 fromthe patient's body. Naturally, if the biocompatible material in thereservoir 110 is hot, the material will be hot also when passing throughthe instrument 120. Hence, the instrument 120 preferably likewiseincludes at least one shield member 125 configured to isolate the bodyfrom liquid material. The material being injected at a high temperaturewill damage the adjacent nerves, thereby reducing the pain to the areaof the joint. Suitable biocompatible materials being liquid at anelevated temperature, and that become solid when cooling off, maycomprise fluoropolymers, e.g. in the form of polytetrafluoroethylene,perfluoroalkoxy and/or fluorinated ethylene propylene.

According to another embodiment, it is presumed that the biocompatiblematerial in the reservoir 110 contains two different components. Each ofthese components is liquid when isolated from the other component.However, when the components are mixed in predefined proportions theydevelop a solid material. Hence, the two components may represent ahardenable component and a hardening agent respectively. In thisembodiment, the reservoir 110 is configured to hold the two componentsseparated from one another during an initial phase of a treatment.During a surgery phase subsequent to the initial phase, the reservoir110 is configured to mix the two components into a mix. Here, thecomponents are mixed in such proportions that the mix remains liquidduring a period required to feed the mix through the instrument 120 tothe at least one damaged joint surface in the joint to be treated.Moreover, the instrument 120 is configured to enable such a conveying ofthe mix.

According to another embodiment, it is presumed that the biocompatiblematerial in the reservoir 110 is liquid due to the fact that thematerial has not yet been exposed to a specific type of radiation. Forexample, the material is configured to be liquid if it has been exposedto electromagnetic radiation whose intensity in a predefined spectrum isbelow a first predefined energy level per unit volume; and the materialis configured to be solid if it has been exposed to electromagneticradiation whose intensity in the predefined spectrum is above a secondpredefined energy level per unit volume. Here, the apparatus includes anelectromagnetic radiation source, which is configured to conveyelectromagnetic radiation in the predefined spectrum to the at least onedamaged joint surface via the instrument 120. Thus, by activating theradiation source after deposition of biocompatible material on the jointsurface, the material may be caused to transition from the liquid formto a solid form.

According to another embodiment, it is presumed that the biocompatiblematerial in the reservoir 110 is liquid due to the fact that thematerial has not yet been exposed to a specific type of mechanicalenergy. For example, the biocompatible material may be configured to beliquid when it has been exposed to ultrasonic energy in a predefinedspectrum whose intensity is below a first predefined energy level perunit volume; and be solid when it has been exposed to ultrasonic energyin the predefined spectrum above a second predefined energy level perunit volume. Here, the apparatus includes an ultrasound sourceconfigured to convey ultrasonic energy in the predefined spectrum to theat least one damaged joint surface via the instrument 120. Thus, byactivating the ultrasound source after deposition of bio compatiblematerial on the joint surface, the material may be caused to transitionfrom the liquid form to a solid form.

Preferably, since the bio compatible material will be deposed in apatient's body, the reservoir 110 and the connection between thereservoir 110 and the instrument 120 are configured to maintain thematerial sterile throughout the entire procedure.

Furthermore, according to all aspects, it is advantageous if theapparatus includes a light source 130 configured to illuminate the jointbeing treated during deposition of the liquid material on at least onedamaged surface of this joint.

FIG. 2 illustrates how a damaged surface S of the hip joint J of apatient is reached according to two embodiments. In both cases the jointJ is accessed through at least one bone of the body, namely either bypassing via the femoral bone 210 or the pelvis bone 220

For example, the distal end D of the proposed instrument 120 may beinserted into the hip joint J by passing via the pelvis bone 220 frominside the abdomen, as illustrated to the right. Here, for reasons ofclarity, FIG. 2 only shows the distal-most end D of the instrument 120as a straight segment. However, of course, in order to reach the jointJ, the instrument 120 may be provided with one or more links (notshown). According to one aspect, the apparatus is surgically placed inthe patient via a laparoscopic abdominal approach, shown in FIG. 6.Specifically, this involves inserting the tube-shaped instrument 120into the abdomen of the patient's body. Gas is then supplied into thepatient's abdomen via the instrument 120, so as to expand the abdominalcavity. At least two laparoscopic trocars are placed in the patient'sbody, and a camera is inserted through one of the laparoscopic trocarsinto the patient's abdomen. Moreover, at least one dissecting tool isinserted through one of the at least two laparoscopic trocars. Themethod further involves dissecting a bone area opposite to the hipregion, and drilling at least one hole in the bone of the patient fromthe abdomen reaching the hip joint, e.g. as illustrated in FIG. 2.Surgery and treatment for treating arthrosis or osteoarthritis of thehip joint J is then performed through this hole by using the proposedapparatus.

Alternatively, the distal end D of the proposed instrument 120 may beinserted into the hip joint J by passing via the femoral bone 210 of thebody, as illustrated to the left in FIG. 2. According to one aspect, theapparatus is surgically placed in the patient via a femoral boneapproach, which involves the following. The patient's skin is cut at thelateral upper femoral region. Then, at least one hole is drilled in thebone of the patient through the upper femoral region reaching the hipjoint J. Finally, surgery and treatment is performed through this atleast one hole for treating arthrosis or osteoarthritis of the hip jointJ by using the proposed apparatus.

Preferably, the step of drilling the at least one hole in the boneinvolves drilling the hole in such a way that a plug of bone is detachedinto the abdomen. Prior to completing the operation, the method furthercomprises replacing the plug.

The instrument 120 may also be configured to be inserted into the jointJ by passing via a capsula of the joint J.

Irrespective of how the joint J is accessed for treatment of arthrosistherein, according to these embodiments, the method involves thefollowing. A volume of a bio compatible material in liquid form is fedinto the reservoir 110 of the apparatus. The reservoir 110 is locatedoutside of a body containing a joint J to be treated. Then, the distalend D of the instrument 120 is inserted into the joint J, and theproximal end P of the instrument 120 is connected to the reservoir 110.Subsequently, the liquid material from the reservoir 110 is received inthe instrument 120. Thereafter, the liquid material is fed from theproximal end P to the distal end D of the instrument 120, such that thematerial is deposed on at least one damaged surface S of the joint J.Finally, the material is caused to transition from the liquid form to asolid form. When in the solid form, the biocompatible material has aresistance to wear adapted to replace a worn out joint surface. Namely,the material is configured to assume the solid form under predefinedconditions, for instance in response to a temperature drop, or exposureto radiation.

FIG. 3 schematically illustrates how a mould member 140 adapted to aconvex joint surface is connected to the proposed apparatus according toone embodiment.

In addition to the embodiment shown in FIG. 1, the apparatus of FIG. 3includes a flexible and collapsible mould member 140. This member 140has a pre-produced shape adapted to a shape and size of at least onedamaged surface of a specific joint, for instance the surface S of thefemoral head represented in FIG. 2. The shape and size of the at leastone damaged surface may be determined via a magnetic resonance imaginginvestigation, a computer tomography x-ray investigation and/or viaarthroscopy. The pre-produced shape of the mould member 140 renders itadapted to contact and cover the joint surface S.

Moreover, the mould member 140 is configured to be inserted into thejoint J in question and be form-fitted to the damaged surface S.Depending on the location and type of joint, fitting the mould member140 to the surface S may require a number of additional instruments (notshown). In any case, the mould member 140 is configured to be connectedto the distal end D of the instrument, 120 and when placed in the jointJ, receive the material in liquid form being fed through the instrument120. The mould member 140 has an internal volume that is configured tobe filled with liquid material received via the instrument 120.Furthermore, after that the mould member 140 has been filled with theliquid bio compatible material, the mould member 140 is configured toenable the predefined conditions, which are required to accomplish atransition of the biocompatible material from the liquid form to thesolid form.

Analogous to the embodiments described above with reference to FIG. 1,the apparatus preferable includes a light source 130, e.g. arranged inthe instrument 120, configured to illuminate the joint being treatedduring deposition of the liquid material in the mould member 140.

It is further advantageous if an arthroscopic instrument being insertedinto the joint along with the instrument 120 includes a camera forviewing the joint.

Equivalent to the instrument 120 as such, the mould member 140 isconfigured to be inserted into the joint J by passing via a bone 210 or220 of the body. This may involve passing via a bone of the body frominside the abdomen, or passing via the femoral bone of the body.

According to some embodiments, the mould member 140 is preferablyadapted to be withdrawn (at least partly) from the joint J after thatthe biocompatible material has assumed its solid form.

FIG. 4 schematically illustrates how a mould member 140 having apre-produced shape adapted to a concave joint surface is connected tothe proposed apparatus according to one embodiment. Here, all referencesigns which also occur in FIG. 1 or 3 designate the samecomponents/features as those described above with reference to thesefigures.

According to one embodiment, the reservoir 110 is configured to hold thematerial at an elevated pressure level exceeding the normal atmosphericlevel. Thus, the mould member 140 may expand in response to receivingthe material. Naturally, this is applicable to any configuration of theproposed mould member (i.e. not just the specific design shown in FIG.4).

Additionally, the apparatus may include an injection member 150configured to inject the liquid material into the mould member 140 atthe elevated pressure. Specifically, the material is injected into themould member 140 through the instrument 120. When the mould member 140has been filled with liquid material, this material is caused totransition from the liquid form to the solid form.

FIG. 5 illustrates how the knee joint J of a patient may be treatedaccording to one embodiment. Here, a mould member 140 is form-fitted toone of the joint surfaces of the femur bone facing the tibia bone 510,for instance by means of the apparatus shown in FIG. 3.

Preferably, in this case, the distal end D of the instrument 120 isconfigured to be inserted into the joint J by passing via a capsula ofthe joint J.

FIG. 6 shows a lateral view of the body of a human patient, with the hipjoint shown in section. The hip joint comprises a caput femur 5 placedat the very top of collum femur 6 which is the top part of the femurbone 7. The caput femur 5 is in connection with the acetabulum 8 whichis a bowl shaped part of the pelvic bone 9. Laparoscopic/Arthroscopictrocars 33 a,b,c is being used to reach the hip joint 39 with one ormore camera 34, a surgical instrument 35 adapted to create a hole in thepelvic bone 9, or instruments 36 for introducing, placing, connecting,attaching, creating or filling a mould or an injected fluid.

FIG. 7 shows an embodiment, wherein the mould is to be used forresurfacing the hip joint. For placing the mould in the hip joint thehip joint needs to be reached, this could be through a hole placed inthe pelvic bone 9, the femoral bone 7 or the hip joint capsule 12. FIG.7 shows the hole 18 in the pelvic bone 9 according to a firstembodiment, the hole 18 is large which allows the mould to pass throughsaid hole 18 in its full functional size.

FIG. 8 shows the hole 20 according to a second embodiment wherein thehole 20 created in a surgical or laparoscopic method is much smallerallowing the surgical instrument creating the hole to be smaller, andthus the incision and dissection performed in the human body. To placethe mould in the joint in this embodiment the mould needs to be flexibleor collapsible.

FIG. 9 shows the hip joint in section when creating a hole in the femurbone 7. The hole in the femur bone passes through the caput femur 5 intothe hip joint and enables the surgeon to reach the hip joint.

FIG. 10 shows the hip joint in section when creating a hole in the hipjoint capsule 12. The hole in the hip joint capsule passes into the hipjoint and enables the surgeon to reach the hip joint.

FIG. 11 a shows an instrument for placing a mould 81 in the hip joint orthe knee joint through a hole in the pelvic bone, the femur bone, thehip joint capsule or an area of the knee. The instrument comprises apiston 89 for transporting the mould 81 into the joint.

FIG. 11 b shows a section of the surgical instrument comprising a tubelike element 90 for housing of said mould 81.

FIG. 11 c shows the surgical instrument according to another embodimentin which the surgical instrument comprises a flexible or bent part 91improving the reach of the surgical instrument. The surgical instrumentaccording to any of the embodiments can be used to place said mould 81inside of a joint in any of the ways described in the followingembodiments.

FIG. 12 shows the step of placing a mould 81 inside of the hip joint ofa human patient through a hole 18 in the pelvic bone 9. The step ofplacing said mould 81 can be performed in a surgical, or in alaparoscopic/arthroscopic method.

FIG. 13 a,b,c,d shows an alternative approach to placing said mould 81in the hip joint of a human patient. Said alternative approach comprisesthe steps of creating a hole 82 in the femur bone 7 following a lengthaxis of the collum femur 6, said hole starting from the lateral side ofthe thigh, penetrating the cortex of the femur bone 7 and eventuallyreaching the cortex of the caput femur 5 from the inside thereof,penetrating said cortex and entering into the hip joint. After thecreation of the hole 82 in the femur bone 7 the mould 81 is insertedinto the hip joint through the hole 82 using the surgical instrument 83according to any of the embodiments above, as shown in FIG. 13 b.

FIG. 13 c shows the mould 81 when being inserted into the hip jointusing the surgical instrument 83 adapted therefore.

FIG. 13 d shows the mould 81 in place after insertion into the hipjoint, the surgical instrument used to place said mould 81 in the hipjoint is retracted after the insertion is completed.

FIG. 14 shows the placing of a mould 81 in a knee 214 in a surgicalmethod. The mould 81 is placed using the surgical instrument accordingto any of the embodiments above.

FIG. 15 shows the placing of a mould 81 in a knee 214 in alaparoscopic/arthroscopic method. The mould 81 is placed using thesurgical instrument according to any of the embodiments above.

After the mould has been placed in the hip or knee joint it is filledwith a fluid adapted to harden to a medical device adapted to serve asat least one artificial joint surface.

FIG. 16 shows the hip joint in section wherein an injecting member 92injects a fluid 93 into a mould 81 in the hip joint through a hole 18 inthe pelvic bone 9 from the opposite side from acetabulum 8. Theinjecting member 92 comprises a piston 94 that pushes said fluid 93 intothe mould 81.

FIG. 17 shows the hip joint in section wherein an injecting member 92injects a fluid 93 into a mould 81 in the hip joint through a hole 82 inthe femur bone 7. The injecting member 92 comprises a piston 94 thatpushes said fluid 93 into the mould 81.

FIG. 18 shows the hip joint in section, wherein an injecting memberinjects a fluid 93 into a mould 81 in the hip joint through a hole inthe hip joint capsule 12. The injecting member 92 comprises a piston 94that pushes said fluid 93 into the mould 81. The fluid 93 is adapted toharden to create a medical device adapted to serve as at least oneartificial hip joint surface.

FIG. 19 shows the hip joint in section wherein the medical device 93′ islocated between the acetabulum 8 and the caput femur 5 which has beencreated by the hardening of the fluid 93 adapted to harden. Said medicaldevice is adapted to serve as at least one artificial hip joint surface.The hole in the pelvic bone is preferably sealed with a bone plug 31 ora prosthetic part 98. The mould 81 used to create the medical device 93′has been removed.

FIG. 20 shows the injecting member 92 according to any of theembodiments above, adapted to inject fluid 93 into a mould 81 in the hipjoint or the knee joint. The injecting member 92 could further beadapted to inject material 93 or a fluid 93 into a connecting areabetween the pelvic bone 9 and a prosthetic part, the pelvic bone 9 and abone plug 31 or the caput femur 5 and a prosthetic part. Said injectingmember 92 comprises a container 107 adapted to hold a fluid 93 forinjection. According to a first embodiment said container 107 comprisestwo compartments 108 a,b adapted to hold two different fluids, saidfluids being adapted to harden when mixed. In the embodiment when thecontainer 107 is adapted to hold two fluids, it is conceivable that theinjecting member 105 further comprises a mixing member 109 wherein saidtwo fluids are being mixed before injection. According to a secondembodiment (not shown) said container 107 is adapted to keep said fluidsterile. According to a third embodiment (not shown) said container 107is adapted to keep said fluid cold or hot and according to a fourthembodiment (not shown) said container 107 is adapted to keep said fluidin a dark environment. Furthermore a combination of the above mentionedembodiments is conceivable.

The term “comprises/comprising” when used in this specification is takento specify the presence of stated features, integers, steps orcomponents. However, the term does not preclude the presence or additionof one or more additional features, integers, steps or components orgroups thereof.

The reference to any prior art in this specification is not, and shouldnot be taken as, an acknowledgement or any suggestion that thereferenced prior art forms part of the common general knowledge inAustralia, or in any other country.

The invention is not restricted to the described embodiments in thefigures, but may be varied freely within the scope of the claims.

1. An apparatus for treatment of arthrosis in a joint of a mammal orhuman patient, the apparatus comprising: a reservoir configured to holda volume of a biocompatible material in liquid form having a temperaturehigher than 100° C. outside of a body containing a joint (J) to betreated, and an instrument having a general tube shape, a distal end (D)of the instrument being configured to be inserted into the joint (J), aproximal end (P) of the instrument (O) being connected to the reservoir(H O) and configured to receive the liquid material there from, theinstrument being configured to feed the liquid material having atemperature higher than 100° C. from the proximal end (P) to the distalend (D) for deposition on at least one damaged surface (S) of the joint(J), such that adjacent nerves are damaged by the heat of the materialthus preventing pain from the damaged surface, the material beingconfigured to assume a solid form under predefined conditions, and whenin the solid form the material having a resistance to wear adapted toreplace a worn out joint surface.
 2. The apparatus according to claim 1,further comprising a flexible and collapsible mould member having apre-produced shape adapted to a shape and size of at least one of the atleast one damaged surface (S) so as to contact and cover this surface(S), the mould member being configured to be inserted into the joint (J)and be form-fitted to said damaged surface (S), be connected to thedistal end (D) of the instrument and when placed in the joint (J)receive the material in liquid form being fed through the instrument,the mould member having an internal volume configured to be filled withliquid material received via the instrument, and the mould member beingconfigured to enable the predefined conditions for accomplishing atransition from the liquid form to the solid form after that the mouldmember has been filled with the liquid material.
 3. The apparatusaccording to claim 2, wherein the mould member is configured to beinserted into the joint (J) by passing via a bone of the body.
 4. Theapparatus according to claim 2, wherein the mould member is configuredto be inserted into the joint (J) by passing via a bone of the body frominside the abdomen.
 5. The apparatus according to claim 2, wherein themould member is configured to be inserted into the joint (J) by passingvia the femoral bone of the body.
 6. The apparatus according to claim 2,wherein the mould member is configured to be inserted into the joint (J)by passing the capsula of said joint (J).
 7. The apparatus according toclaim 2, wherein the mould member is configured to be at least partlywithdrawn from the joint (J) after that the material has assumed itssolid form.
 8. The apparatus according to claim 2, wherein the reservoiris configured to hold the material at an elevated pressure levelexceeding the normal atmospheric level, and the mould member isconfigured to expand in response to receiving the material.
 9. Theapparatus according to claim 8, comprising an injection memberconfigured to inject the liquid material into the mould member at theelevated pressure.
 10. The apparatus according to claim 2, wherein themould member comprises an isolation material configured to reduce therisk of body tissue being damaged by the liquid material having atemperature above 37 degrees Celsius.
 11. The apparatus according toclaim 1, wherein the reservoir is configured to hold the biocompatiblematerial at a temperature of at least 100 degrees Celsius.
 12. Theapparatus according to claim 1, wherein the reservoir comprises at leastone shield member configured to isolate the reservoir from the body. 13.The apparatus according to claim 1, wherein the instrument comprises atleast one shield member configured to isolate the body from liquidmaterial passing through the instrument.
 14. The apparatus according toclaim 1, wherein the reservoir is configured to hold the biocompatiblematerial at a temperature of at least 50 degrees Celsius.
 15. Theapparatus according to claim 1, wherein the reservoir is configured tohold the biocompatible material at a temperature of at least 70 degreesCelsius.
 16. The apparatus according to claim 1, wherein the reservoiris configured to hold the biocompatible material at a temperature of atleast 90 degrees Celsius.
 17. The apparatus according to claim 1,wherein the reservoir is configured to hold the biocompatible materialat a temperature of at least 150 degrees Celsius.
 18. The apparatusaccording to claim 1, wherein the reservoir is configured to hold thebiocompatible material at a temperature of at least 200 degrees Celsius.19. The apparatus according to claim 1, wherein the reservoir isconfigured to hold the biocompatible material at a temperature of atleast 300 degrees Celsius.
 20. The apparatus according to claim 1,wherein the reservoir is configured to hold the biocompatible materialat a temperature of at least 400 degrees Celsius. 21.-71. (canceled)